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Eur J Cardiothorac Surg 2003;24:898-905
© 2003 Elsevier Science NL

Long term follow-up of left ventricular performance and size of the great arteries before and after one- and two-stage arterial switch operation of simple transposition

^a Department of Pediatric Cardiology, Christian Albrechts University, Schwanenweg 20, 24105 Kiel, Germany
^b Department of Cardiovascular Surgery, Christian Albrechts University, Schwanenweg 20, 24105 Kiel, Germany

Received 16 April 2003; received in revised form 29 August 2003; accepted 10 September 2003.

^* Corresponding author. Tel.: +49-431-5971727; fax: +49-431-5971828
e-mail: kramer{at}pedcard.uni-kiel.de

Objective: Long-term angiographic evaluation of left ventricular performance and size of the great arteries after one-stage neonatal versus two-stage arterial switch operation (ASO) of simple transposition. Methods: Analysis of cineangiographic studies obtained during the process of two-stage ASO for 34 patients and after neonatal repair for 52 patients. Results: At early follow-up after two-stage ASO the left ventricular enddiastolic volume (LVEDV) was +1.8 standard deviations (S.D.) larger than LVEDV of control patients, but normalized completely (0.0 S.D.) at late follow-up. In contrast, after neonatal repair the LVEDV was always normal, and the median EF was significantly higher than after two-stage ASO (73 vs. 68%). The diameters of the native pulmonary annulus and sinus increased significantly after pulmonary artery banding to +4.5 and +4.8 S.D., respectively. After ASO, a significant decrease of the respective sizes occurred from early to late follow-up (annulus: +6.0 to +2.1 S.D.; sinus: +7.1 to +4.1 S.D.). After neonatal ASO the neoaortic annulus and sinus were only +1.5 and +2.7 S.D. larger than the comparable normal structures. The differences to the two-stage group were significant. In both groups, the neoaortic anastomosis had no diameters significantly different from normal. After one- and two-stage repair, the size of the neopulmonary annulus and sinus decreased similarly in both groups from early to late follow-up (annulus +0.9 to -2.4 S.D.; +0.3 to -2.8 S.D.; sinus: -0.7 to -1.6 S.D.; -0.7 to -1.8 S.D.). Conclusions: Neonatal ASO has definite advantages over two-stage repair concerning LV-performance and the degree of dilation of the neoaortic root. The significantly reduced size of the neopulmonary root after both procedures is remarkable, but fortunately mostly without clinical significance.

Key Words: Simple transposition • Arterial switch operation • Left ventricular function • Great arteries

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